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Check-Up Erroneousy Billed as an Emergency Visit

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  • 01-15-2018, 12:40 AM
    whatisthis
    Check-Up Erroneousy Billed as an Emergency Visit
    My question involves collection proceedings in the State of: MS

    Background: This hospital is notorious for not billing correctly. My girlfriends's mom went in for her yearly checkup (it's 100% covered). The Doc asked her how she was doing (as they always do), she said fine but her neck hurt from the morning and said she herself said she probably slept on it wrong. The doc said that's probably what it is, advised some Advil and told her to call her if it didn't get better in a few days...that's the end of that story. Till she gets a bill for $3,000+. Her insurance told her the doctor's office didn't bill it as a checkup, but billed it as an emergency visit, and when she called the doctor's office the receptionist said "oh yeah you came in here complaining about your neck and this and that". Wow!

    Anyways, I got a call from a previous eye doc's office (same hospital system) last week saying I have $30 odd dollar bill due. I asked what it was regarding, she didn't answer my question, just told me the insurance paid their amount and I have to paid the $30 sum dollars. I said it was a checkup which is 100% covered except the $10 co-pay which I already paid and I told her you probably didn't bill it correctly and advised her to bill it as a checkup. Her response: "no problem, i'll send it to collections, BYE!"

    Questions...if they send it to collections and I pay collections right away...does it take a hit on my credit report? Is there any way to dispute this and say they aren't willingly it correctly? Without spending hours and going to court and this and that...it's $30 lol.
  • 01-15-2018, 06:44 AM
    free9man
    Re: Office Doesn't Bill Correctly, What Should I Do
    IS your credit being trashed and the time you have to spend getting it fixed worth only $30? First thing you should do is check your Explanation of Benefits that your ins. company should have sent you. You do check those when you get them, right? Then you should contact your insurance company to see what they might be able to do. If that fails, pay the bill the instant you get it to save your credit. Better yet, go to the doctor's office and pay them before it becomes delinquent in any fashion. Then worry about fighting to get it back.
  • 01-15-2018, 08:21 AM
    jk
    Re: Office Doesn't Bill Correctly, What Should I Do
    First:
    if this is a managed health care insurance (ppo, hmo) you need to enlist the assistance of your insurance. The providers are contractually obligated to treat billing in a certain manner. Opening a discussion with your insurance provider is a first step.

    Second;
    there is almost always a higher level person to speak with. Calmly and respectfully ask to speak with a higher up level person. Sometimes doing things in person nets better results. Sometimes there is an office manager that is the person you want to speak with. Sometimes it is a distinct billing department supervisor. That is specific to your situation.

    Third
    given you had an appointment for an annual checkup it’s kind of silly a provider would turn a report of an ailment into an emergency services treatment. I mean, aren’t you supposed to be telling the doctor all your ills and complaints when you go for an annual? I know my doctor asks me about any concerns or complaints I have. That’s kind of the purpose of the appointment.

    The one thing that concerns me. You said this is a hospital. Why are people going to a hospital for regular services such as an annual check up and an optometrist’s or even opthamologists appointment? While there are often medical offices associated with hospitals, I don’t tend to see a hospital providing such services.
  • 01-15-2018, 10:23 AM
    adjusterjack
    Re: Office Doesn't Bill Correctly, What Should I Do
    One possibility is that a service that is preventative and covered 100% becomes diagnostic when a condition is reported.

    I had that happen a few years ago with a colonoscopy.

    It was covered 100% as a routine preventative exam.

    But polyps were found so it got billed as diagnostic and I ended up paying about half the cost due to deductible and coinsurance.

    When is this country going to wake up to medical billing being a colossal scam?
  • 01-15-2018, 11:34 AM
    hr for me
    Re: Office Doesn't Bill Correctly, What Should I Do
    Quote:

    Quoting adjusterjack
    View Post
    One possibility is that a service that is preventative and covered 100% becomes diagnostic when a condition is reported.

    I had that happen a few years ago with a colonoscopy.

    It was covered 100% as a routine preventative exam.

    But polyps were found so it got billed as diagnostic and I ended up paying about half the cost due to deductible and coinsurance.

    When is this country going to wake up to medical billing being a colossal scam?

    I got double billed years ago on my ultrasound for my first pregnancy because they "diagnosed" twins -- there's Baby A and there's Baby B -- no measurements or extra work done. But got charged for 2! Later ultrasounds, they actually did two sets of measurements, etc so I understood, but the ultrasound that found two babies, really that's just one diagnosis? But insurance did pay both!
  • 01-15-2018, 11:53 AM
    jk
    Re: Office Doesn't Bill Correctly, What Should I Do
    Quote:

    Quoting adjusterjack
    View Post
    One possibility is that a service that is preventative and covered 100% becomes diagnostic when a condition is reported.

    I had that happen a few years ago with a colonoscopy.

    It was covered 100% as a routine preventative exam.

    But polyps were found so it got billed as diagnostic and I ended up paying about half the cost due to deductible and coinsurance.

    When is this country going to wake up to medical billing being a colossal scam?

    But that involved a different procedure (snipping rather than just looking). With the op there was no additional exam (at least as stated). The receiving of a telling of ailments is what one would expect from the question;

    Quote:

    The Doc asked her how she was doing
    so are you suggesting that a doctor can covert an annual exam where one is supposed to disclose ailments and issues into an “emergency visit” by answering a question that is part of the annual check up?

    And since when does one schedule emergency trips to the hospital? Given it was scheduled (presumably) well before the visit, even considering it an urgent care visit is improper.

    If anything it might be a valid charge as a regular office visit but changing it to an emergency visit? Totally wrong.


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